Atlas of temporal bone surgery

217 Pages·2010·26.78 MB·English

by  Ulug

Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010
FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei
Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010
FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei
Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010
FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei
Atlas of Temporal Bone Surgery
ProfessorTuncay Ulug,MD
IstanbulUniversity
IstanbulMedicalFaculty
DepartmentofOtorhinolaryngology
Istanbul,Turkey
345illustrations
Thieme
Stuttgart·NewYork
Thieme-Verlag Sommer-Druck Ulug: WN025415/01/01 5.3.2010
FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei
IV
Library of Congress Cataloging-in-Publication Data is available from Importantnote:Medicineisanever-changingscienceundergoingcon-
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V
“If the discoloration extends right through the bone, it must
beexcisedandalldiseasemustbeextirpated.Ifthereissound
bone beneath, it suffices to remove that which is diseased. It
isjustthesamewhethertheskull,thebreastboneoraribbe
affected with caries; cauterization is useless. Excision is
imperative.”
Celsus, 2000yearsago…1
“TrephinedskullofNeolithicperiodthatshowshealedwoundedgesindicat-
ingrecoveryfromanoperationwhosepurpose,whethermedicalormagi-
cal,remainsunknown.”2
1BallanceC.Mastoidoperation:aglimpseintoitshistory.ArchivesofOtolaryngology
1932;6:55–75(WithreferrencetoPietzckerF.Celsus:LiberMedicinaeOctavus.Caput2.
Tübingen.)
2Nationalmuseet,Copenhagen;PhotographbyLennartLarsen.In:LyonsA.S.,Petrucelli
R.J.Medicine:AnIllustratedHistory.NewYork:HarryN.AbramsInc.Publishers;1987.Re-
producedwithpermission.
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VI
About the Author
ProfessorTuncayUlug,MD,graduatedfromIstanbulFacultyofMedicine,IstanbulUniversity,in1987,andon
completinghispostgraduatetraininginotolaryngologyatthesameinstitutionin1991,hejoinedthefaculty
asanacademician.Between1993and2001,overvaryingperiods,heattendedseveralwell-reputedclinicsin
otology,neurotology,skullbasesurgeryandtumorsurgery,includingZürichUniversity,St.James’sHospital,
Memorial Sloan–Kettering Cancer Center, New York University, Mount Sinai University, George Washington
University—NeurosurgicalDepartment,theMayoClinic,andtheHouseEarInstitute.Inthisway,afterhaving
learnedthemodernpracticesassimilatedover nearly80yearsinhisinstitution,andalong withtheworkof
manyexperiencedandskilledcolleaguesaroundtheworld,hewasinspiredmainlybytheearandskullbase
techniques of Ugo Fisch, the otologic and neurotologic concepts of the House school, the neurosurgical per-
spectivesoftheskullbasesurgeonLaligamSekhar,andthetumorphilosophyofJatinShah.ProfessorUlugis
currentlyaconsultantat theDepartmentof Otorhinolaryngology—Head and Neck Surgery,Istanbul Medical
Faculty,IstanbulUniversity.
ProfessorUlug’sclinicalinterestsencompasstheareasofotology,neurotology,skullbasesurgeryandsome
fieldsoftumorsurgery.Hehasdeliveredmanyscientificpresentationsandhascontributedtomanynational
andinternationalscientificpublications.HeisamemberofseveralsocietiesincludingthePolitzerSocietyand
theEuropeanAcademyofOtology/Neuro-Otology.Since1998,ascoursedirector,hehasorganizedtheannual
“International Istanbul Temporal Bone Dissection and Otology/Neurotology Courses,” which attracts partici-
pantsfromcountriesfromallovertheworld.
ProfessorUlugdesignedtherevolutionary“Ulugdouble-sidedearmicrosurgeryinstruments,”whichhave
beenproducedbyKarlStorz(Tuttlingen,Germany)since2007.Hehasalsopioneeredseveralsurgicaltechni-
quesandproposedanumberof landmarks,andiscurrentlyinvolvedinthedevelopmentofnewmiddleear
prosthesesandmoresurgicalinstruments.
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VII
Preface
Otologyandneurotologyhavebecomeanincreasinglyimportant Definition, Indications, Anatomical Orientation, Surgical Steps,
benchmarkformodernmicrosurgeryoverthepastcoupleofdec- and Definitions and Tips; for some techniques, there is an addi-
ades.Themasteryofdelicatetechniquesandexecutionofsurgical tional part on surgical anatomy. Under the surgical steps, the
perfection in this type of high-risksurgerycan only be acquired concepts of the most important landmark (MIL) and the ideal
through tremendous effort by those wishing to advance in this instrument(II)aimtodescribethemostcriticalreferencepoints
area.Todevelopthebasicskillsrequiredforthissurgery,tempo- and the surgical instruments necessary for each particular stage
ral bone dissections, and related courses and atlases, are the ofprocedure.Additionalinformationrequiredforeachparticular
mainpracticaleducationaltoolsavailable. stageispresentedtothereaderasDefinitionsandTipsatthebot-
This atlas is intentionally entitled Temporal Bone Surgery tomofthepage,precludingtheneedtorefertoothersources.
rather thanTemporal Bone Dissection. This is because the proce- Thethirdsectionofthebookincludesdefinitionsofthesurgi-
durescarriedoutonacadaverboneareexactlythesameasthose cal techniques described and used by the author, and presents
carriedoutduringaliveoperation—theonlydifferencebeingthe surgicalinstrumentsdesignedbytheauthor.
absenceofblood.Furthermore,notonlyarethecharacteristicsof The glossary in thefourth section comprises the main termi-
the laboratory dissection explained in the descriptions of the nologyusedinotologyandneurotology,inalphabeticalorder.In
techniques,butalsothoseoflivesurgery. this part, the terms are described and beneficial tips are also
The main principle during temporal bone dissections is to given.Inaddition,eachtermhasbeenclassifiedaseitheranana-
carryoutasmanyproceduresaspossibleoneachbone.Also,dur- tomical or a surgical definition. The reader should refer to the
ingtheliveoperation,differentproceduresarecarriedouteither glossaryasandwhennecessary.
insequenceorsimultaneously,inmanyinstances.Therefore,this From the technical publishing perspective, along with the
atlas illustrates more than one procedure being executed and unique way of teaching the procedures step by step, aided by
presentedineachboneand,consequently,thesequenceofsurgi- illustrations and descriptions, full-page color photographs and
cal techniques presented throughout this atlas is not based on labeled orientationphotographs havebeen included for thefirst
theory,butonsurgicalpractice. time in such a medical publication. The full-page color photo-
The four principal sections of this book are: General Aspects, graphs show the details and make the book more attractive to
Surgical Techniques, Techniques and Designs Developed by the read, and the orientation photographs enable easy and precise
Author, and Appendix with Glossary. To gain a comprehensive three-dimensionalperceptionofeachtechniquewithoutcreating
understandingofthecontentsofthisbook,allsectionsshouldbe confusion.Furthermore,theillustrationsofthesurgicalstepsare
read in sequence. However, beforebeginning to read the princi- generouslylabeled,enablingaquickandefficientrun-throughof
pal sections, the reader should first go over thelist of abbrevia- theprocedures.
tions, so that the labeling of illustrations may be understood Finally, I would like to express my sincere gratitude to Neil
moreeasily. Warrington and Cameron Shaw for their invaluable contribu-
The GeneralAspectssectionisimportantfrom asurgicalper- tions, and toStephan Konnry, Annie Hollins, ElisabethKurz, and
spective.Inthissection,readerswillfindanswerstomanyques- the editorial and production staff at Thieme Publishers for their
tions relating to otologic and neurotologic practice, and tips on closecollaborationandefficientassistanceinrealizingthisardu-
how toimprovetheir surgical skills,including the precise useof ouspublication.
theburr. I hope that this book will provide readers with the basic, yet
TheSurgicalTechniquessectionmakesupthemainandmost essential,knowledgeofskillsrequiredwhilecarryingoutotologic
comprehensive part of the atlas. In this section, each surgical and neurotologic procedures, both in the laboratory and in the
technique is described step bystep in detail using photographic operatingroom.
illustrations,allofwhichhavebeentakenbytheauthor,showing
theprocedurescarriedoutbytheauthor.Eachchapterisdevoted ProfessorTuncayUlug,MD
toaparticular techniqueandissubdividedintopartsasfollows: Istanbul,Turkey
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FrauKurz Feuchtwangen AtlasofTemporal TN147151 Titelei
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IX
Contents
I GeneralAspects ...................................................................... 1 10 Canalplasty ............................................................................. 49
Definition ............................................................................. 49
1 Introduction............................................................................ 3 Indications ............................................................................ 49
AnatomicalOrientation ......................................................... 49
2 SurgicalAnatomy ................................................................... 3 SurgicalSteps........................................................................ 51
3 SurgicalTheory....................................................................... 4 11 Antrotomy ............................................................................ 53
Definition ........................................................................... 53
4 InstrumentationandUsage ................................................... 5 Indications .......................................................................... 53
Microscope............................................................................... 5 AnatomicalOrientation ....................................................... 53
TheDrillandMicrosurgeryInstruments ................................... 5 SurgicalSteps...................................................................... 55
KeyPointsinBurrUsage ........................................................ 6 SurgicalAnatomy.................................................................. 56
BurrUsageinBleedingControl............................................... 7
BurrUsagearoundtheCriticalStructures ............................... 8 12 Tympanoplasty ..................................................................... 57
Definition ........................................................................... 57
Indications .......................................................................... 57
II SurgicalTechniques................................................................ 13 AnatomicalOrientation ....................................................... 57
SurgicalSteps...................................................................... 59
5 CorticalMastoidectomy......................................................... 15
Definition ............................................................................. 15 13 Stapedotomy ........................................................................ 63
Indications ............................................................................ 15 Definition ........................................................................... 63
AnatomicalOrientation ......................................................... 15 Indications .......................................................................... 63
SurgicalSteps........................................................................ 17 AnatomicalOrientation ....................................................... 63
SurgicalAnatomy.................................................................. 23 SurgicalSteps...................................................................... 65
6 PosteriorTympanotomy ........................................................ 25 14 IntactBridgeAtticotomy ..................................................... 69
Definition ............................................................................. 25 Definition ........................................................................... 69
Indications ............................................................................ 25 Indications .......................................................................... 69
AnatomicalOrientation ......................................................... 25 AnatomicalOrientation ....................................................... 69
SurgicalSteps........................................................................ 27 SurgicalSteps...................................................................... 71
SurgicalAnatomy.................................................................. 30
15 PartialBridgeAtticotomy .................................................... 75
7 CochlearImplantation............................................................ 31 Definition ........................................................................... 75
Definition ............................................................................. 31 Indications .......................................................................... 75
Indications ............................................................................ 31 AnatomicalOrientation ....................................................... 75
AnatomicalOrientation ......................................................... 31 SurgicalSteps...................................................................... 77
SurgicalSteps........................................................................ 33
16 Atticotomy............................................................................ 79
8 TranscorticalExposureoftheEpitympanum........................ 37 Definition ........................................................................... 79
Definition ............................................................................. 37 Indications .......................................................................... 79
Indications ............................................................................ 37 AnatomicalOrientation ....................................................... 79
AnatomicalOrientation ......................................................... 37 SurgicalSteps...................................................................... 81
SurgicalSteps........................................................................ 39
SurgicalAnatomy.................................................................. 42 17 Atticoaditotomy ................................................................... 83
Definition ........................................................................... 83
9 ExtendedCorticalMastoidectomy ........................................ 43 Indications .......................................................................... 83
Definition ............................................................................. 43 AnatomicalOrientation ....................................................... 83
Indications ............................................................................ 43 SurgicalSteps...................................................................... 85
AnatomicalOrientation ......................................................... 43
SurgicalSteps........................................................................ 45 18 Atticoantrotomy................................................................... 87
Definition ........................................................................... 87
Indications .......................................................................... 87
AnatomicalOrientation ....................................................... 87
SurgicalSteps...................................................................... 89